DECEMBER 2009 VOLUME XXXVIII NUMBER 12 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

179	Hemostasis Using a Bipolar Sealer in Primary Unilateral Total Knee Arthroplasty German A. Marulanda, MD, Victor E. Krebs, MD, Benjamin E. Bierbaum, MD, Victor M. Goldberg, MD, Michael Ries, MD, Slif D. Ulrich, MD, Thorsten M. Seyler, MD, and Michael A. Mont, MD Dr. Marulanda is Resident, Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, Florida. Previous studies have shown that, compared with standard electrocautery, a bipolar sealer reduces tissue damage and smoke production during surgery. We conducted a multicenter, prospective, randomized study to compare a bipolar sealer with standard electrocautery for hemostasis. Sixty-nine primary total knee arthroplasties were performed. Cohorts were evaluated for intraoperative and postoperative blood loss, blood transfusion requirements, postoperative hemoglobin and pain levels, length of hospital stay, range of motion, and Knee Society scores. Amount of blood loss and decrease in postoperative hemoglobin were significantly lower in the bipolar sealer group than in the standard electrocautery group. Need for autologous blood transfusions was decreased in the bipolar sealer group compared with the electrocautery group. There were no between-groups differences in clinical knee scores. The bipolar sealer was an effective coagulation alternative for total knee arthroplasties in reducing blood loss and transfusion requirements without affecting clinical outcome. Am J Orthop. 2009;38(12):E179-E183.
184	Pantaloon Hip Spica Cast and Constrained Liner for the Treatment of Early Total Hip Dislocation in a Young Patient With Sickle Cell Disease John P. Meehan, MD, Amir A. Jamali, MD, and James A. Ryan, MD Dr. Meehan is Associate Professor, Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California. Abstract not available. Introduction provided instead. Sickle cell disease often leads to osteonecrosis of the femoral head and subsequent degenerative arthritis of the hip. Pain and ambulatory limitations prompt orthopedic surgeons to consider total hip arthroplasty (THA). In these patients, THA can be challenging secondary to distorted anatomy, prior surgeries, and significant soft-tissue contractures. The case reported here illustrates early prosthetic dislocation after THA in a young patient with sickle cell disease successfully treated with open reduction, conversion to a constrained liner, and 8 weeks in a pantaloon hip spica cast. The authors have obtained the patient’s written informed consent for print and electronic publication of the case report. Am J Orthop. 2009;38(12):E184-E186.
187	Diffuse Pigmented Villonodular Synovitis of the Ankle With Severe Bony Destruction: Treatment of a Case by Surgical Excision With Limited Arthrodesis Hiroyuki Mori, MD, Yuji Nabeshima, MD, Makoto Mitani, MD, Akihiro Ozaki, MD, Hideo Fujii, MD, and Ryosuke Kuroda, MD Dr. Mori is Staff Orthopaedic Surgeon, Department of Orthopaedic Surgery, Himeji St. Mary’s Hospital, Himeji, Japan. Abstract not available. Introduction provided instead. Pigmented villonodular synovitis (PVNS) is a relatively rare disease affecting the synovial-lined joints. It was first fully described in 1941, by Jaffe and colleagues,1 as a benign inflammatory state of the synovium of unclear etiology and as a tumorlike aggression of synovial tissue involving joints. The disease can be diffuse or localized and either intra-articular or extra-articular.2 Diffuse PVNS involves the entire joint synovium; localized PVNS involves a discrete nodular, lobulated mass.3 The disease commonly occurs in the knee joint, whereas involvement of the foot and ankle is rare4 (reported incidence, ~1.8/million5). Severity of bony involvement in PVNS of the ankle may be high, possibly because the pressure erosion easily occurs in the narrow joint space of the ankle joint.6 The recurrence rate for the diffuse type may be as high as 50%, whereas the rate for the localized type is considered low.2,5,7 So, to avoid tumor spread, complete excision and careful tissue handling are essential. However, a more curative approach causes more structural morbidity to the joint, which may necessitate a more invasive procedure, such as talocrural arthrodesis, depending on location of the lesion. Thus, the surgeon faces a difficult choice between aggressive surgery and more conservative treatment. Here we report a case of diffuse PVNS of the ankle with severe bony destruction, most of which originated in the distal tibiofibular joint (DTFJ). As this rare location was accessible, complete resection and arthrodesis only of the DTFJ were sufficient for curative operation. The authors have obtained the patient’s written informed consent for print and electronic publication of the case report. Am J Orthop. 2009;38(12):E187-E189.

601	Will Granny Be Able to Get Her Rotator Cuff Repaired? James P. Tasto, MD Dr. Tasto, this journal’s Department Editor for Socioeconomics and Practice Management, is Clinical Professor, Department of Orthopaedic Surgery, University of California, San Diego, and is affiliated with San Diego Sports Medicine & Orthopaedic Center, San Diego, California. Abstract not available. Am J Orthop. 2009;38(12):601.
602	An Arthroscopic-Plus-Open Method of Repair for Combined Tears of the Subscapularis, Supraspinatus, and Infraspinatus Tendons David Capiola, MD, and Glen Ross, MD Dr. Capiola is from Beth Israel Hospital and is Attending Orthopaedic Surgeon, New York Methodist Hospital, Brooklyn, New York. Tears involving the subscapularis and posterosuperior rotator cuff comprise a distinct clinical entity. An aggressive treatment involving operative repair has demonstrated superior results compared with delayed intervention, yet there is no consensus as to the optimal method of repair. Various methods are evolving, but they are not without their pitfalls. Methods of fixation, patient positioning, and biceps management are emerging as points of contention. In this technical note, we describe an arthroscopic-plus-open approach in which arthroscopic repair of the posterosuperior rotator cuff is followed by an open subscapularis repair. Advantages of this method include ability to address concomitant pathology, relative ease of repair, and creation of a strong, reliable construct. The interval- splitting approach affords minimal additional morbidity and does not preclude use of allograft or biological augmentation for salvage procedures. Overall, this method is an effective, efficient technique that yields reproducible, reliable repair of these combined rotator cuff tears. Am J Orthop. 2009;38(12):602-605.
606	Hip Fracture Outcome: Is There a “July Effect”? Kane L. Anderson, MD, MS, Kenneth J. Koval, MD, and Kevin F. Spratt, PhD Dr. Anderson is Resident, Department of Orthopaedics, Dartmouth Medical School, Lebanon, New Hampshire. We assessed the differential complications and mortality rates of teaching versus nonteaching hospitals in July against other month-to-month differences in a cohort of 324,988 elderly patients hospitalized for a femoral neck or intertrochanteric fracture (data taken from the 1998–2003 National Inpatient Sample). Demographics were similar between teaching and nonteaching hospitals and across admission months. The overall mortality rate was 3.64% and was slightly higher in teaching hospitals compared with nonteaching hospitals (3.69% vs. 3.61%, relative risk [RR] = 1.0062, 95% CI 0.99-1.02). The adjusted relative risk (RR) for mortality in July/August was significantly higher than the overall adjusted RR and compared with all other month pairs, indicating higher in- hospital mortality rates in teaching hospitals compared with nonteaching hospitals. Intraoperative complications and length of stay were statistically significantly greater in teaching hospitals but did not demonstrate a “July effect.” Teaching hospitals had lower perioperative complication rates. Elderly hip fracture patients treated at teaching hospitals had 12% greater relative risk of mortality in July/August (ie, experience a “July effect”) compared with nonteaching hospitals during that time period (1998-2003). Although various methods exist for exploring the “July effect,” it is critical to take into account inherent month-to-month variation in outcomes and to use nonteaching hospitals as a control group. Am J Orthop. 2009;38(12):606-611.
612	Randomized Prospective Evaluation of Adjuvant Hyaluronic Acid Therapy Administered After Knee Arthroscopy Geoffrey Westrich, MD, Sarah Schaefer, BA, Sarah Walcott-Sapp, BA, and Stephen Lyman, PhD Dr. Westrich is Associate Professor of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York. Intra-articular injections of hyaluronic acid products may eliminate pain, improve mobility and quality of life, and delay osteoarthritis progression. In this study, we evaluated the safety and efficacy of sodium hyaluronate injections given after knee arthroscopy. Forty-six patients with early osteoarthritis and a symptomatic meniscus tear were prospectively randomized into study (injection) and control groups and underwent knee arthroscopy. Study patients received 3 sodium hyaluronate injections after surgery. Study and control outcomes were compared 3 and 6 months after surgery. The injection patients had significantly less pain (visual analog scale) at 3-month follow-up and more flexion at 6-month follow-up. Tenderness, pain on motion, and crepitus were significantly more likely to be absent from injection patients at the 3- and 6-month follow-ups. Patients with osteoarthritis and a symptomatic meniscus tear may experience more pain relief and functional mobility after arthroscopic surgery plus hyaluronic acid injections than after arthroscopy alone. Am J Orthop. 2009;38(12):612-616.
617	Reproducibility of Radiographic Measurements in Assessment of Congenital Talipes Equinovarus John Thometz, MD, Robert Manz, MD, Xue-Cheng Liu, MD, PhD, John Klein, PhD, and Barbara Manz-Friesth, DNS, RN Dr. Thometz is Chief of Pediatric Orthopedics, Department of Orthopaedic Surgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, and Professor, Medical College of Wisconsin, Milwaukee, Wisconsin. Six commonly measured parameters in the assessment of congenital clubfoot were retrospectively assessed from standardized preoperative and intraoperative radiographs taken during operative complete subtalar release. These radiographic parameters were measured in 30 feet by 6 observers at 2 separate readings. The observers were orthopedic residents in different stages of training. Between- observers intraclass correlation coefficients (ICCs) were computed for each parameter. All radiographic parameters were found to be reproducible across time and observers (range of preoperative intraobserver ICCs, 0.84-0.99; range of preoperative interobserver ICCs, 0.93-0.99), except for intraoperative anteroposterior (AP) talar–first metatarsal angle (intraoperative intraobserver ICC, 0.79) and lateral talocalcaneal angle (intraoperative interobserver ICC, 0.81). Differences in mean preoperative measurements between observers and time were tested by analysis of variance. There were no significant differences between observers and time in the 6 preoperative measurements (P>.05), except for intraoperative AP talar–first metatarsal angle, AP talocalcaneal angle, and degree of AP calcaneocuboid subluxation, which were significantly different (P<.05). Our results support use of radiographs as a reliable method for guiding care in patients with clubfoot and as a reproducible method that physicians can use for comparisons. Am J Orthop. 2009;38(12):617-620.
621	Tibial Plateau Fracture With Proximal Tibia Autograft Harvest for Foot Surgery Gregory J. Galano, MD, and Justin K. Greisberg, MD Dr. Galano is Resident, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York. Abstract not available. Am J Orthop. 2009;38(12):621-623.
624	Arthroscopic Rotator Cuff Repair Failure Resulting From Decortication of the Rotator Cuff Footprint: A Case Report Michael J. DeFranco, MD, Jonathan R. Pribaz, BS, and Brian J. Cole, MD, MBA Dr. DeFranco is with Orthopaedic Surgical Consultants, P.C., and Lenox Hill Hospital, New York, New York. Abstract not available. Am J Orthop. 2009;38(12):624-625.
626	Endobutton-Assisted Repair of Complete Distal Biceps Tendon Rupture in a Woman Jason C. Eck, DO, MS, and Seth D. Baublitz, DO Dr. Eck is Assistant Professor, Department of Orthopaedic Surgery, University of Massachusetts, Worcester, Massachusetts Abstract not available. Am J Orthop. 2009;38(12):626-628.
630	Are You Red Flag Ready? Cheyenne Brinson, MBA, CPA; for KarenZupko & Associates, Inc. Ms. Brinson is Consultant and Speaker, KarenZupko & Associates, Inc., Chicago, Illinois. Abstract not available. Am J Orthop. 2009;38(12):630-632.
633	Reverse Passage of the Suture Lasso in Arthroscopic Rotator Cuff Repair Michael S. George, MD Dr. George is Clinical Instructor, University of Texas Medical School at Houston, Houston, Texas. Suture passage in arthroscopic rotator cuff repair can be technically difficult. The suture lasso is typically passed antegrade from the bursal side of the rotator cuff. Antegrade passage of the suture lasso can be particularly difficult when visualization is limited. Reverse passage of the suture lasso from the undersurface can be used to place sutures in technically challenging circumstances. The suture lasso is placed retrograde through the undersurface of the rotator cuff and used as a suture shuttle to bring sutures back through the rotator cuff. This technique is easily reproducible and cost-effective, and it requires only 2 working arthroscopy portals. Am J Orthop. 2009;38(12):633-634.
635	Pigmented Villonodular Synovitis Benjamin T. Addicott, BS, MS, Jean Jose, DO, Lee D. Kaplan, MD, and Paul D. Clifford, MD Mr. Addicott is Medical Student, Department of Radiology, the University of Miami Miller School of Medicine, Miami, Florida. Abstract not available. Am J Orthop. 2009;38(12):635-636.

back to top